Associations of perceived changes in work due to digitalization and the amount of digital work with job strain among physicians: a national representative sample.

BACKGROUND: Physicians' work is often stressful. The digitalization of healthcare aims to streamline work, but not all physicians have experienced its realization. We examined associations of perceived changes in work due to digitalization and the amount of digital work with job strain among physicians. The moderating role of the length of work experience was investigated for these associations. METHODS: We used representative survey data on Finnish physicians' (N = 4271) experiences of digitalization from 2021. The independent variables included perceptions on statements about work transformations aligned with digitalization goals, and the extent that information systems and teleconsultations were utilized. Stress related to information systems (SRIS), time pressure, and psychological stress were the dependent variables. We analyzed the associations using multivariable linear and logistic regressions. RESULTS: Respondents had a mean SRIS score of 3.5 and a mean time pressure score of 3.7 on a scale of 1-5. Psychological stress was experienced by 60%. Perceptions associated with higher SRIS comprised disagreements with statements asserting that digitalization accelerates clinical encounters (b = .23 [95% CI: .16-.30]), facilitates access to patient information (b = .15 [.07-.23]), and supports decision-making (b = .11 [.05-.18]). Disagreement with accelerated clinical encounters (b = .12 [.04-.20]), and agreements with patients' more active role in care (b = .11 [.04-.19]) and interprofessional collaboration (b = .10 [.02-.18]) were opinions associated with greater time pressure. Disagreeing with supported decision-making (OR = 1.26 [1.06-1.48]) and agreeing with patients' active role (OR = 1.19 [1.02-1.40]) were associated with greater psychological stress. However, perceiving improvements in the pace of clinical encounters and access to patient information appeared to alleviate job strain. Additionally, extensive digital work was consistently linked to higher strain. Those respondents who held teleconsultations frequently and had less than 6 years of work experience reported the greatest levels of time pressure. CONCLUSIONS: Physicians seem to be strained by frequent teleconsultations and work that does not meet the goals of digitalization. Improving physicians' satisfaction with digitalization through training specific to the stage of career and system development can be crucial for their well-being. Schedules for digital tasks should be planned and allocated to prevent strain related to achieving the digitalization goals.

New evidence on the association of occupation with amyotrophic lateral sclerosis: A register-based case-control study in Finland.

Objectives: Amyotrophic lateral sclerosis (ALS) is a serious neurodegenerative disease that usually leads to death within a few years from diagnosis. The risk factors for ALS are still largely unknown. However, it is assumed that environmental factors play a role in disease onset. Occupation is suggested as a potential risk factor, but findings are inconsistent. The aim of this study was to assess the association of occupation with ALS in Finland. Register data were used to avoid recall bias and to obtain a large enough sample to detect the potential associations. Methods: This case-control study included ALS cases that occurred between 1980 and 2015 in Finland (n = 4,781). ALS cases were identified from the causes of death register. For each ALS case, six controls were selected matched for sex and birth-year. The date of death of the ALS case was set as index date. Information on occupation was obtained from Statistics Finland for all subjects. The focus was on the longest-held occupation on 2-digit level (70 groups). The association of occupation with ALS was analyzed using conditional logistic regression. Results: Compared to "clerical work and other office work," the risk of ALS was increased in "packing and wrapping work" (OR 1.53, 95% CI 1.08-2.17), "laundering, dry cleaning and pressing work" (OR 1.83, 95% CI 1.08-3.08), and "travel service work" (OR 8.75, CI 2.76-27.74). A decreased risk was found in "planning, administrative and research work in the technical fields" (OR 0.69, 95% CI 0.48-0.98). Of the significant associations identified, only "travel service work" was significant after FDR multiple testing correction. Conclusions: This study identified occupations in which the risk of ALS was increased. Further studies are needed to pinpoint the potential exposures in these occupations that may trigger the disease.

A screening tool for the risk of disability retirement due to musculoskeletal disorders.

Objective This study aimed to develop and validate a risk screening tool using a points system to assess the risk of future disability retirement due to musculoskeletal disorders (MSD). Methods The development population, the Health 2000 Survey, consisted of a nationally representative sample of Finnish employees aged 30-60 years (N=3676) and the validation population, the Helsinki Health Study, consisted of employees of the City of Helsinki aged 40-60 years (N=6391). Both surveys were linked to data on disability retirement awards due to MSD from national register for an 11-year follow-up. Results The discriminative ability of the model with seven predictors was good (Gönen and Heller's K concordance statistic=0.821). We gave points to seven predictors: sex-dependent age, level of education, pain limiting daily activities, multisite musculoskeletal pain, history of arthritis, and surgery for a spinal disorder or carpal tunnel syndrome. A score of 3 or higher out of 7 (top 30% of the index) had good sensitivity (83%) and specificity (70%). Individuals at the top 30% of the risk index were at 29 [95% confidence interval (CI) 15-55) times higher risk of disability retirement due to MSD than those at the bottom 40%. Conclusion This easy-to-use screening tool based on self-reported risk factor profiles can help identify individuals at high risk for disability retirement due to MSD.

Separate and combined associations of pain and emotional exhaustion with sickness absence.

Pain and emotional exhaustion are prevalent conditions with consequences for sickness absence. Although they often co-occur, their combined associations with sickness absence are poorly understood. This study aimed to examine the separate and combined associations of pain and emotional exhaustion with subsequent sickness absence. The data were derived from a cross-sectional questionnaire survey sent to 40 to 60-year-old employees of the City of Helsinki in 2000 to 2002 (n = 6457) linked with the City of Helsinki personnel register information on sickness absence (3 years on from the survey). Self-certified (1-3 days) and medically certified sickness absence spells (4-14 days, more than 14 days) were used as outcomes. Acute and chronic pain and emotional exhaustion were measured in a questionnaire survey. For the purposes of this study, sickness absence and pain variables were merged to form a new variable with 6 mutually exclusive categories. The main statistical method was negative binomial regression analysis. The synergy index was used to estimate the interaction. Among women, acute and chronic pain with and without emotional exhaustion predicted sickness absence, particularly absence lasting for more than 2 weeks, whereas emotional exhaustion alone did not. The associations persisted when further adjusted for socioeconomic and sociodemographic factors, health-related behaviors, and somatic and mental health. A synergistic interaction effect was found for co-occurring pain and emotional exhaustion on medically certified sickness absence. The results for men were mainly similar, but less stable. In order to tackle sickness absence, special attention should be paid to the prevention and treatment of employees with co-occurring pain and emotional exhaustion.

The associations between psychosocial working conditions and changes in common mental disorders: a follow-up study.

BACKGROUND: Common mental disorders (CMD) are prevalent in working populations and have adverse consequences for employee well-being and work ability, even leading to early retirement. Several studies report associations between psychosocial working conditions and CMD. However, there is a lack of longitudinal research within a broad framework of psychosocial working conditions and improvement in CMD. The aim of this study was to examine the associations between several psychosocial working conditions and deteriorating and improving CMD among ageing employees over a five-to-six-year follow-up period. METHODS: The study is based on the Helsinki Health Study baseline survey in 2001-2002 and a follow-up in 2007 (N = 4340, response rate 83%) conducted among 40-60-year-old female and male employees. The General Health Questionnaire (GHQ-12) was used to measure common mental disorders. Psychosocial working conditions were measured in terms of job strain, organisational justice, work-family interface, social support and workplace bullying. The covariates included sociodemographic and health factors. RESULTS: Following adjustment for all the covariates, family-to-work (OR 1.41, 95% Cl 1.04-1.91) and work-to-family conflicts (OR 1.99, 95% Cl 1.42-2.78) and workplace bullying (OR 1.40, 95% Cl 1.09-1.79) were associated with deterioration, and family-to-work conflicts (OR 1.65, 95% Cl 1.66-2.34) and social support (OR 1.47, 95% Cl 1.07-2.00) with improvement in CMD. CONCLUSIONS: Adverse psychosocial working conditions contribute to poor mental health among employees. Preventing workplace bullying, promoting social support and achieving a better balance between work and family may help employees to maintain their mental health.

Changes in working conditions and subsequent sickness absence.

OBJECTIVES: The aim of the study was to examine the associations of changes in exposure to physical and psychosocial working conditions on subsequent sickness absence among ageing municipal employees of the City of Helsinki, Finland. METHODS: Changes in exposure to working conditions were assessed between baseline (2000-2002) and follow-up (2007) surveys. Register-based sickness absence information was linked to the survey data (N=3739) and followed-up from the return of the questionnaire in 2007 to the end of 2010. The study included six measures of physical and two measures of psychosocial working conditions. Negative binomial regression analysis was used to assess the associations and adjust for covariates. RESULTS: Favorable changes in physical working conditions lowered the risk for sickness absence whereas adverse changes increased the risk. Adverse changes in psychosocial working conditions only slightly increased the risk for sickness absence whereas favorable changes were unassociated with sickness absence. CONCLUSIONS: Changes in exposure to physical working conditions in particular are associated with subsequent sickness absence. Preventing an increase in exposure to both psychosocial and physical working conditions and promoting a decrease in exposure to physical working conditions likely helps reduce the risk of sickness absence.

Cohort profile: the Helsinki Health Study.

The Helsinki Health Study cohort was set up to enable longitudinal studies on the social and work related determinants of health and well-being, making use of self-reported as well as objective register data. The target population is the staff of the City of Helsinki, Finland. Baseline data for the cohort were derived from questionnaire surveys conducted in 2000, 2001 and 2002 among employees reaching 40, 45, 50, 55 or 60 years of age in each year. The number of responders at baseline was 8960 (80% women, response rate 67%). Additional age-based health examination data were available. A follow up survey was conducted in 2007 yielding 7332 responders (response rate 83%). Measures of health include health behaviours, self-rated health, common mental disorders, functioning, pain, sleep problems, angina symptoms and major diseases. Social determinants include socio-demographics, socio-economic circumstances, working conditions, social support, and work-family interface. Further register linkages include sickness absence, hospital discharge, prescribed drugs, and retirement updated at the end of 2010. The cohort allows comparisons with the Whitehall II study, London, UK, and the Japanese Civil Servants Study from western Japan. The cohort data are available for collaborative research at Hjelt Institute, Department of Public Health, University of Helsinki, Finland.

Working conditions as risk factors for disability retirement: a longitudinal register linkage study.

BACKGROUND: Early retirement due to disability is a public health and work environment problem that shortens working careers. Transition to disability retirement is based on ill-health, but working conditions are also of relevance. We examined the contributions of work arrangements, physical working conditions and psychosocial working conditions to subsequent disability retirement. METHODS: The data were derived from the Helsinki Health Study cohort on employees of the City of Helsinki, Finland. Information on working conditions was obtained from the baseline surveys conducted in 2000, 2001 and 2002. These data were linked with register data on disability retirement and their main diagnoses obtained from the Finnish Centre for Pensions. Follow up by the end of 2008 yielded 525 disability retirement events. The analysed data included 6525 participants and 525 disability retirement events. Hazard ratios (HR) and 95% confidence intervals (95% CI) were calculated from Cox regression analysis. RESULTS: Several working conditions showed own associations with disability retirement before adjustment. After adjustment for all working conditions, the primary risk factors for all-cause disability retirement were physical workload among women (HR 2.02, 95% CI 1.57-2.59) and men (HR 2.00, 95% CI 1.18-3.38), and low job control among women (HR 1.60, 95% CI 1.29-1.99). In addition, for disability retirement due to musculoskeletal causes, the risk factors were physical workload and low job control. For disability retirement due to mental causes the risk factors were computer work and low job control. Furthermore, occupational class was a risk factor for disability retirement due to all causes and musculoskeletal diseases. CONCLUSIONS: Among various working conditions, those that are physically demanding and those that imply low job control are potential risk factors for disability retirement. Improving the physical working environment and enhancing control over one's job is likely to help prevent early retirement due to disability.

Pain and disability retirement: a prospective cohort study.

This study examined the association of pain with subsequent disability retirement due to all causes as well as musculoskeletal diseases, mental disorders, and a heterogeneous group of other diseases and to study whether pain has an effect of its own after taking into account long-standing illness, physician-diagnosed diseases, working conditions, and occupational class, which are the key factors affecting disability retirement. The data consisted of the Helsinki Health Study baseline survey linked to national pension register data (n=6258). Mean follow-up time was 8.1 years. The data included 594 disability retirement events. Pain (acute or chronic) was stratified by long-standing illness (yes/no). Cox regression analysis was performed. Chronic pain without and with co-occurring long-standing illness was strongly associated with all types of disability retirement outcomes, but the associations were particularly strong for disability retirement due to musculoskeletal diseases. The associations remained even when further adjusted for physician diagnosed chronic conditions and diseases, psychosocial and physical working conditions, and occupational class. Associations for acute pain were also found, but they were clearly weaker than those of chronic pain. Chronic pain contributes to disability retirement. Prevention and effective treatment of chronic pain may help prevent early retirement due to disability.

Low back pain and neck pain as predictors of sickness absence among municipal employees.

OBJECTIVE: To study whether having ever had local low back pain (LBP), sciatica, neck pain (NP), or some combination of LBP and NP, predicts sickness absence among municipal employees. METHODS: The study sample (n=6911, 80% women, response rate 67%) included employees of the City of Helsinki who reached the age of 40, 45, 50, 55, or 60 years between 2000-02. Survey data on pain, working conditions, and health behaviours were linked to register data on sickness absence for three subsequent years. Sickness absence was categorised as self-certified (lasting for 1-3 days) and medically certified (lasting for 4 days or more) and the number of spells during the follow up was analysed using Poisson regression analysis. RESULTS: In women, medically certified sickness absence was predicted by sciatica (rate ratio, RR, 1.3, 95% CI 1.1-1.6), NP (RR 1.3, 95% CI 1.2-1.5) and the combination of sciatica and NP (RR 1.8, 95% CI 1.6-2.1), allowing for working conditions, body mass index, and smoking. In men, the corresponding RRs were 1.5 (95% CI 1.0-2.1), 1.7 (95% CI 1.2-2.4), and 2.2 (95% CI 1.6-2.9). Local LBP did not predict medically certified sickness absence. Self-certified sickness absence was modestly predicted by all pain categories in women (RRs between 1.2 and 1.5) and by NP alone and with local LBP or sciatica in men (RRs between 1.4 and 1.6). CONCLUSIONS: Medically certified sickness absence was predicted by sciatica and NP, but not by local LBP. The association was accentuated in those with both sciatica and NP. Pain combinations may have a stronger effect on work ability than pain in one location.

Workplace bullying and common mental disorders: a follow-up study.

BACKGROUND: Workplace bullying has been associated with mental health, but longitudinal studies confirming the association are lacking. This study examined the associations of workplace bullying with subsequent common mental disorders 5-7 years later, taking account of baseline common mental disorders and several covariates. METHODS: Baseline questionnaire survey data were collected in 2000-2002 among municipal employees, aged 40-60 years (n=8960; 80% women; response rate 67%). Follow-up data were collected in 2007 (response rate 83%). The final data amounted to 6830 respondents. Workplace bullying was measured at baseline using an instructed question about being bullied currently, previously or never. Common mental disorders were measured at baseline and at follow-up using the 12-item version of the General Health Questionnaire. Those scoring 3-12 were classified as having common mental disorders. Covariates included bullying in childhood, occupational and employment position, work stress, obesity and limiting longstanding illness. Logistic regression analysis was used. RESULTS: After adjusting for age, being currently bullied at baseline was associated with common mental disorders at follow-up among women (OR 2.34, CI 1.81 to 3.02) and men (OR 3.64, CI 2.13 to 6.24). The association for the previously bullied was weaker. Adjusting for baseline common mental disorders, the association attenuated but remained. Adjusting for further covariates did not substantially alter the studied association. CONCLUSION The study confirms that workplace bullying is likely to contribute to subsequent common mental disorders. Measures against bullying are needed at workplaces to prevent mental disorders.

Psychosocial work environment and emotional exhaustion among middle-aged employees.

BACKGROUND: This study examined the associations of job control, organizational justice and bullying at the workplace with emotional exhaustion. This was done by adjusting firstly for age and occupational class, secondly physical work factors, thirdly mutually adjusting for the three psychosocial factors and fourthly adjusting for all studied variables simultaneously.Data were derived from the Helsinki Health Study baseline surveys conducted in 2001 and 2002, including 40-60-year-old employees of the City of Helsinki (n = 5819, response rate 66%). Exhaustion was measured with a six-item subscale from Maslach Burnout Inventory (MBI). Psychosocial factors included Karasek's job control, organizational justice and bullying at the workplace. Logistic regression analysis was used. RESULTS: Among women 23% and among men 20% reported symptoms of emotional exhaustion. Among women all psychosocial factors were associated with exhaustion when adjusted for age and occupational class as confounders. When physical work factors were additionally adjusted for, the associations slightly attenuated but remained. When psychosocial work factors were simultaneously adjusted for each other, their associations with exhaustion attenuated but remained. Among men all psychosocial factors were associated with exhaustion when adjusted for confounders only. When adjusted for physical work factors the associations slightly attenuated. When psychosocial factors were simultaneously adjusted for each other, associations of organizational justice and bullying with exhaustion attenuated but remained whereas job control lost its association. CONCLUSIONS: Identifying risk factors for emotional exhaustion is vital for preventing subsequent processes leading to burnout. Psychosocial factors are likely to contribute to exhaustion among female as well as male employees. Thus management and occupational health care should devote more attention to the psychosocial work environment in order to be able to prevent exhaustion and burnout at the workplaces.

Psychosocial risk factors of pain among employees.

The study of psychosocial risk factors of pain among employees has typically focused on Karasek's job-demand-control model. The aim of the study was to examine the own and independent associations of job strain, organizational justice, workplace bullying, and work-home interface with pain. Data were collected through a postal survey to all 40, 45, 50, 55, and 60-year-old employees of the City of Helsinki in 2001 and 2002 (response rate 66%, N=5819, 80% women). Pain was measured with a three category outcome: no pain, acute pain or chronic pain. Adjustment was made for age, education, physical working conditions, BMI, smoking, and alcohol consumption. Among women, all psychosocial variables were associated with both acute and chronic pain when adjusted for confounders only. When psychosocial factors were additionally adjusted for each other, high job strain and both dimensions of work-home interface remained associated with both types of pain and repeatedly occurring bullying at workplace showed association with acute pain. Among men, when adjusted for confounders only, all psychosocial variables were associated with acute and chronic pain, except for family-to-work conflicts among those with acute pain. When adjusted mutually for all psychosocial variables, only bullying was associated with acute pain. Job strain and organizational justice showed associations with chronic pain. Future studies would benefit from a broad psychosocial framework. Investments to healthier psychosocial working environments are needed to tackle pain related problems among employees.

Register-based study among employees showed small nonparticipation bias in health surveys and check-ups.

OBJECTIVES: To examine nonparticipation to a questionnaire survey and occupational health check-ups by sociodemographic variables and health status, measured by medically confirmed sickness absence, and whether the associations between other study variables and participation were affected by health status. STUDY DESIGN AND SETTING: Questionnaire surveys and health check-ups were conducted among the City of Helsinki employees. Sample information was derived from the employer's personnel register and analyzed by participation and giving consent to link the data to external administrative registers. RESULTS: Participation to the questionnaire survey was more common among the older, higher occupational classes, those with higher income, permanent employment, and those with no absence due to medically confirmed sickness. Among women in particular, the differences were small. Consent giving followed generally similar patterns than survey response. Nonparticipation to health check-ups was related to low income and temporary employment contract. In both questionnaire survey and health check-ups, associations between other study variables and participation were not affected by health status. CONCLUSIONS: Questionnaire surveys and health check-ups were broadly representative of the target population. Associations between other study variables and participation did not differ by health status. This suggests that even when the data are not fully representative associations between the study variables need not to be biased.

Pain and health related functioning among employees.

STUDY OBJECTIVE: Although employees report high rates of pain, little is known about the effects of pain on health related functioning among them. This study examined the effects of pain on employees' health related functioning by bodily locations of pain, number of painful locations, and whether pain was acute or chronic. DESIGN: Cross sectional questionnaire survey. Data on pain and health related functioning as measured with the eight subscales of the short form 36 health survey (SF-36) were obtained in the years 2001 and 2002. SETTING: Municipal employees of the City of Helsinki, Finland. PARTICIPANTS: All employees who reached the age of 40, 45, 50, 55, and 60 years during each study year. Response rate was 66% (n = 5829). MAIN RESULTS: Compared with those reporting no pain, those with pain had considerably poorer functioning on all SF-36 subscales. The lowest scores for health related functioning were seen in the physical domain of health, whereas the mental domain was less affected. The association of pain with functioning was practically independent of the bodily location of pain. Whether pain was acute or chronic had only a modest effect on functioning. Widest variation in functioning was found by the number of painful locations. CONCLUSIONS: Among employees pain complaints, irrespective of the location, are associated with a decreased level of functioning. The number of painful locations is likely to be the most useful measure to identify employees with a high risk of poor functioning.

Occupational class inequalities across key domains of health: results from the Helsinki Health Study.

BACKGROUND: Studies comparing socioeconomic inequalities in health using several health indicators are scarce. Therefore, this study aims to compare the shape and magnitude of occupational class inequalities across key domains of health, i.e. the subjective, functional and medical domains. Additionally, we examine whether physical or mental workload will affect these inequalities, and whether these effects are specific to particular health indicators. METHODS: Cross-sectional survey data from the Helsinki Health Study in 2000 and 2001 were used. Each year employees of the City of Helsinki, reaching 40, 45, 50, 55 and 60 years received a mailed questionnaire. 6243 employees responded (80% women, response rate 68%). The socioeconomic indicator was occupational social class. Nine health indicators were included: self-rated health, pain or ache, GHQ-12 mental well-being, limiting long-standing illness, SF-36 physical and mental health functioning, Rose angina symptoms, circulatory diseases and mental problems. Prevalence percentages, odds ratios and inequality indices from logistic regression analysis were calculated. RESULTS: Occupational class inequalities were found for self-rated health, pain or ache, limiting long-standing illness, physical health functioning, angina symptoms, and circulatory diseases. Physical or mental workload did not account for these inequalities. Inequalities were non-existent or slightly reversed for GHQ-12 mental well-being, SF-36 mental health functioning and mental problems. CONCLUSION: Expected occupational class inequalities in health among both women and men were found for global and physical health but not for mental health. The observed inequalities could not be attributed to physical or mental workload.

A comparative study of the patterning of women's health by family status and employment status in Finland and Sweden.

The main aim of this study is to compare the patterning of health by family status and employment status among women in Finland and Sweden and to explore whether the patterning of health by family status is influenced by employment status and income. An additional aim was to identify which combinations of family status and employment status are especially disadvantageous for women's health . The data derived from comparable interview surveys carried out in 1994/1995. The analyses were restricted to ages 25-49; 2282 women in Finland and 2685 in Sweden. Firstly, age-adjusted prevalence percentages were presented by family status and employment status. Secondly, the patterning of health by family status and employment status, and the influence of adjusting for income, were studied by logistic regression analysis. The main results showed that women living in couples with children had the best health in both countries. Additional analyses showed that in Finland particularly poor health can be found among women who are simultaneously non-partnered and non-employed, whereas in Sweden poor health can be found among all non-employed groups of women. Income did not explain the poor health among the non-partnered and non-employed. This study confirmed that health is patterned by family status and employment status both among Finnish and Swedish women. It was found that non-employed women without a partner are likely to have poor health. In order to reduce inequalities in health among women, more efforts should be put on promoting health among these groups.

Socio-economic differences in the prevalence of acute, chronic and disabling chronic pain among ageing employees.

Pain is a strong predictor of reduced work ability and well-being, but there is little information on the prevalence of and socio-economic differences in acute, chronic and disabling chronic pain among employees. A questionnaire survey conducted in 2000-2002 among employees aged 40, 45, 50, 55 and 60 of the City of Helsinki (N=8970, response rate 67%) included socio-demographic and socio-economic factors and measures of current pain, pain duration and pain-related disability. Pain was acute when lasting a maximum of 3 months and chronic when persisting for more than 3 months. Disabling chronic pain was determined using the disability subscale of Von Korff's Chronic Pain Grade questionnaire. Acute pain was reported by 15% of women, chronic pain by 29% and disabling chronic pain by 7%. The corresponding figures for men were 12, 24 and 5%. Chronic and disabling chronic pain were more common in older age groups among both genders. Among women, those with secondary or basic education were more likely to report chronic or disabling chronic pain than those with higher education, and semi-professionals, routine non-manual employees and manual workers were more likely to report disabling chronic pain than managers. Among men, separated/divorced or widowed men were more likely to report acute pain than married men, and manual workers were more likely to report chronic pain than managers. Chronic pain was relatively common in this population, and those with older age, lower education and occupational class appear to be at excess risk for chronic pain, especially for disabling chronic pain.